IBD and pregnancy: What expectant mothers should know

For years, women with inflammatory bowel disease (IBD) were so concerned about how their disease could affect their ability to have a baby that they would take the idea off the table.

“Some women with IBD simply chose not to pursue pregnancy because of their fear that it wasn’t possible for them, or that they’d pass on their disease,” said Sushila Dalal, MD, a University of Chicago Medicine gastroenterologist.

Dalal helps her patients put those worries to rest. “Women with IBD can have healthy pregnancies,” she said.

Still, it’s vital for moms-to-be to create a plan with their care team that keeps the disease in remission before and during pregnancy. “The most important thing is that the mom is healthy in order to have a healthy baby,” Dalal said. “As long as the mom is in remission and the disease is under control, she can have a healthy pregnancy.”

That plan should include gastrointestinal care. “Patients sometimes don’t realize they need to talk with their GI team about pregnancy, because they think it’s a separate area,” Dalal said.

UChicago Medicine provides a comprehensive, multidisciplinary GI team — including gastroenterologists, colorectal surgeons, ostomy nurses, IBD-specific dietitians, and pre-conception counselors — to help women with IBD during every step of their pregnancy.

Dalal answered some common questions she hears from patients:

I have IBD. What should I do before I get pregnant?

Meet with your healthcare team early so they can answer any and all of your medication and nutrition questions and can come up with a medication and vitamin plan for your pregnancy.

At UChicago Medicine, your team might include an obstetrician who’s also a maternal-fetal medicine specialist trained in taking care of patients with chronic conditions. And if you’re due for any monitoring, such as a colonoscopy, your team can schedule it before your pregnancy.

“We make sure the patient is up to date on all their IBD maintenance and that they’re in a stable spot,” Dalal said.

I have IBD and want to have a baby. When is the best time to conceive?

“It’s really important that women are in stable remission for at least three months before conceiving,” Dalal said.

Before getting pregnant, visit your GI team so they can ensure your bowel is healed and you’re in remission.

To make sure your bowel is healthy and you don’t have an active flare, which can make it more difficult to get pregnant, your team might administer an MRI, blood test or stool test. UChicago Medicine also offers noninvasive intestinal ultrasounds.

Is it safe to stay on IBD medications while pregnant?

Most medications for IBD are safe, but there are a few, such as methotrexate, that should be stopped before getting pregnant. Again, talk with your doctor to come up with a medication plan — and stick to it throughout the pregnancy.

“What we don’t want is people to panic and stop their medicines and then they have a flare of their disease during pregnancy, because that’s actually a lot more dangerous,” Dalal said.

I’ve had IBD-related surgery. What does that mean for my pregnancy?

Women who have Crohn’s disease or ulcerative colitis might have had a surgery, such as an ostomy or a J-pouch, that can cause scar tissue, making it more difficult for some women to become pregnant. But with assistive reproductive technologies, these individuals can still carry a pregnancy.

During pregnancy, women who have had surgeries face special considerations.

For instance, a woman who has had an ostomy might find that her ostomy bag fits differently as she goes through the different stages of pregnancy, or she might have partial bowel blockages as her belly grows. She’ll need to meet with her healthcare team so they can adjust the bag or slightly modify her diet, among other things.

I’m pregnant and having an IBD flare-up. What now?

“We treat it just as we always would,” Dalal said. The healthcare team first determines what’s causing the flare, then administers or adjusts medications to get it under control.

“We don’t want to withhold therapies because we’re worried about giving medicine during pregnancy,” Dalal said. “What we’re worried about is having the disease uncontrolled.”

What should I do while I’m pregnant?

Maintain routine healthcare follow-ups during pregnancy, including appointments with your gastroenterologist, to monitor the health of yourself and the fetus, and to ensure the IBD stays in remission.

Also, consult with a maternal-fetal medicine obstetrician to come up with a monitoring plan. In some cases, women don’t need additional monitoring during pregnancy. Others might need an ultrasound or some other monitoring.

“They should make sure they take care of themselves and manage their disease because that’s something they’re doing both for themselves and for their baby,” Dalal said.

Can pregnancy worsen IBD symptoms?

In general, no — as long as you remain in remission before and during the pregnancy and you take your medications. “As long as patients are well beforehand and they stay on what’s keeping them well, we expect them to continue to be in remission,” Dalal said.

Will I pass IBD on to my children?

This is a common concern, Dalal said. If someone has a parent, sibling or child with IBD, they do have a higher risk of getting it.

Still, while genetic susceptibility plays a role, it doesn’t mean a mother definitely will pass IBD on to her baby. “Genetics are only part of the puzzle of what causes IBD,” Dalal said.